What happened to Mitch McConnell?

[thegenius]

You guys see that video of him? He was talking and just froze.



So much speculation that he had a TIA or a stroke…or absense seizure.

I think no way this was ischemic in nature. I suppose it could have been a partial seizure, maybe an absense seizure but he is definitely out of the age group for that.

To me it looks like he just stared into space for awhile. We all do that. Notice how he conveniently wakes up when someone addresses him?

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[HemeOncHopeful19]

Malfunction in the robot circuitry that is being controlled by the tiny lizard-man somewhere inside him IMO, had to be rebooted.

(I would say the same about a democrat politician too btw)

 

[RustedFox]

He just feeb'ed out.
I'm so happy that so many of our nation's decision makers are ancient vasculopaths.

 

[MechEDoc]

I think he just needed to be power cycled.

My guess is a TIA.

 

[thegenius]

Malfunction in the robot circuitry that is being controlled by the tiny lizard-man somewhere inside him IMO, had to be rebooted.

(I would say the same about a democrat politician too btw)

Yea Biden does this every day!!!

 

[thegenius]

I think he just needed to be power cycled.

My guess is a TIA.

It just has so few characteristics of a TIA. TIAs don’t make you freeze like that. He didn’t move a muscle for 20ish seconds. What part of the brain do you make transiently ischemic to produce that? The basiliar artery?

 

[JacobMcCandles]

I assume he was pooping his pants.

 

[Emapp20177]

It just has so few characteristics of a TIA. TIAs don’t make you freeze like that. He didn’t move a muscle for 20ish seconds. What part of the brain do you make transiently ischemic to produce that? The basiliar artery?

possibly a TIA with aphasia, no?

 

[RustedFox]

It just has so few characteristics of a TIA. TIAs don’t make you freeze like that. He didn’t move a muscle for 20ish seconds. What part of the brain do you make transiently ischemic to produce that? The basiliar artery?

Visual cortex. He saw weird stuff, got tripped out, and froze - not knowing what to say or do.

Either that, or he saw Jesus.

 

[FlaminHotER]

TIA

 

[FlaminHotER]

I believe something very similar happen to Dr. Ron Paul while live on his broadcast a couple years ago

 

[Tenk]

It’s called being too fing old to hold public office. Biden does this all the time. Here is Feinstein doing a speech instead of a simple approval: CNN on TikTok

These people all belong in a nursing home. Not Congress and the Oval Office.

 

[Siggy]

Malfunction in the robot circuitry that is being controlled by the tiny lizard-man somewhere inside him IMO, had to be rebooted.

(I would say the same about a democrat politician too btw)

A Feinstein for a McConnell seems like an even trade.

 

[Kryptocoin]

Doesn't seem like a TIA. He was quickly arousable and responded to questions been asked. The guy is looking quite old and frail. Can barely walk.

I do support age limits for all branches of federal government including the Supreme Court.

 

[Torsion]

absence seizure?

 

[bravotwozero]

I heard he was break dancing

 

[Apollyon]

Rick Jeanneret did that on a Sabres broadcast a few years ago. If you're a hockey fan, you might know Rick. He was doing play by play, then just went silent. There was about 20 seconds of nothing, then one of the intermission hosts was immediately pressed into duty. Turns out, he had a TIA. Not because of that, but, Rick is now retired.

 

[thegenius]

possibly a TIA with aphasia, no?

Have you ever seen a TIA where the pt is motionless and speechless? I have not. I won’t put the probability at 0, but it’s very very low IMO. Moreover he responds when spoken to. It’s more likely a simple partial seizure (if that was pathology).

Some other congressman or senator had a video of him talking and he actually had a TIA or stroke. I think it was rand Paul or Ron paul, can’t remember.

I read all these twitter comments and everyone is like call 911 STAT!!! One MD! wrote “he needs a stat head CT!!!!”

Jeez

 

[thegenius]

Visual cortex. He saw weird stuff, got tripped out, and froze - not knowing what to say or do.

Either that, or he saw Jesus.

Maybe he was simply staring at a nice rack in the audience and just froze

 

[thegenius]

I believe something very similar happen to Dr. Ron Paul while live on his broadcast a couple years ago

Yea! But he had clear expressive aphasia my leopard gecko would have identified that

 

[thegenius]

Rick Jeanneret did that on a Sabres broadcast a few years ago. If you're a hockey fan, you might know Rick. He was doing play by play, then just went silent. There was about 20 seconds of nothing, then one of the intermission hosts was immediately pressed into duty. Turns out, he had a TIA. Not because of that, but, Rick is now retired.

So all the negative testing suggested a TIA?

We ascribe too many very brief, transient neurologic phenomena inappropriately IMO to TIAs.

 

[RustedFox]

Maybe he was simply staring at a nice rack in the audience and just froze

1. Nice.

2. Didn't Biden recently blurt out: "I am the AI!" in response to some question about AI?

 

[RustedFox]

3. McConnell just then remembered where he left his bag of cocaine.

 

[BJJVP]

Near syncope? idk

 

[Siggy]

So all the negative testing suggested a TIA?

We ascribe too many very brief, transient neurologic phenomena inappropriately IMO to TIAs.

By definition if there’s imaging of a lesion it’s a stroke not a TIA.

Just like it’s impossible to push TPA for a TIA. Once the TPA goes in it becomes an aborted stroke.

 

[thegenius]

1. Nice.

2. Didn't Biden recently blurt out: "I am the AI!" in response to some question about AI?

I think he said “all your base are belong to us”. Then just stared

 

[thegenius]

By definition if there’s imaging of a lesion it’s a stroke not a TIA.

Just like it’s impossible to push TPA for a TIA. Once the TPA goes in it becomes an aborted stroke.

Oh I’m aware. A Tia is a diagnosis of exclusion and has no positive test. I was pulling that guys leg if it wasn’t obvious.

 

[Siggy]

I think he said “all your base are belong to us”. Then just stared

Oh I’m aware. A Tia is a diagnosis of exclusion and has no positive test. I was pulling that guys leg if it wasn’t obvious.

Ah. You'd be surprised though... I had attendings in residency who was trying to argue that the patient with active deficits were having a TIA and that their blood pressure needed better control.

 

[thegenius]

So I don't think McConnell had anything ischemic at all. I think he just had old brain. Have you ever talked to someone....you can kind of tell their drifting off and thinking of other stuff...and just stare and not do anything? Then they shake their head and say "what was that you said?"

McConnell had the old version of that, whatever that is called. He will get an MRI, an EEG and be on an ASA and statin if he isn't already.

 

[RustedFox]

So I don't think McConnell had anything ischemic at all. I think he just had old brain. Have you ever talked to someone....you can kind of tell their drifting off and thinking of other stuff...and just stare and not do anything? Then they shake their head and say "what was that you said?"

McConnell had the old version of that, whatever that is called. He will get an MRI, an EEG and be on an ASA and statin if he isn't already.

Young people have weird symptoms, are diagnosed with anxiety attacks, and get prescriptions for Xanax.
Old people have weird symptoms, are diagnosed with TIAs, and get prescriptions for Plavix.

There. I just made it easy.

 

[Postictal Raiden]

It doesn’t appear stroke/TIA. That wasn’t aphasia. It was an arrest of speech/behavior with alteration of consciousness.

Absence-like (true absence seizure is a specific childhood epilepsy) seizure is possible. These seizures are typically accompanied by automatism (such as lip smacking or other repetitive purposeless motor behavior).

However, most likely it’s something related to BP or blood sugar.

Let’s call it toxic metabolic encephalopathy and call it a day.

 

[Siggy]

It doesn’t appear stroke/TIA. That wasn’t aphasia. It was an arrest of speech/behavior with alteration of consciousness.

Absence-like (true absence seizure is a specific childhood epilepsy) seizure is possible. These seizures are typically accompanied by automatism (such as lip smacking or other repetitive purposeless motor behavior).

However, most likely it’s something related to BP or blood sugar.

Let’s call it toxic metabolic encephalopathy and call it a day.

Sorry... not enough information. Can you please answer the following query?

Based on your assessment is this
1. Acute Toxic Metabolic Encephalopathy
2. Chronic Toxic Metabolic Encephalopathy
3. Acute on Chronic Toxic Metabolic Encephalopathy
4. Toxic Metabolic Encephalopathy has been ruled out
5. Other (Please provide supporting information)

 

[John Rawls]

Have you ever seen a TIA where the pt is motionless and speechless? I have not. I won’t put the probability at 0, but it’s very very low IMO. Moreover he responds when spoken to. It’s more likely a simple partial seizure (if that was pathology).

Some other congressman or senator had a video of him talking and he actually had a TIA or stroke. I think it was rand Paul or Ron paul, can’t remember.

I read all these twitter comments and everyone is like call 911 STAT!!! One MD! wrote “he needs a stat head CT!!!!”

Jeez

I would not let you take care of my family.

 

[Rendar5]

It doesn’t appear stroke/TIA. That wasn’t aphasia. It was an arrest of speech/behavior with alteration of consciousness.

Absence-like (true absence seizure is a specific childhood epilepsy) seizure is possible. These seizures are typically accompanied by automatism (such as lip smacking or other repetitive purposeless motor behavior).

However, most likely it’s something related to BP or blood sugar.

Let’s call it toxic metabolic encephalopathy and call it a day.

an arrest of speech sounds awfully much like an aphasia…that’s like my patients trying to tell me it’s a pain in their head, not a headache.

He couldn’t talk and on the videos I saw the right side of his face drooped or had some weird motions. I agree that partial seizure of some sort could have occurred. But still just as likely a TIA.

 

[NYEMMED]

Sorry... not enough information. Can you please answer the following query?

Based on your assessment is this
1. Acute Toxic Metabolic Encephalopathy
2. Chronic Toxic Metabolic Encephalopathy
3. Acute on Chronic Toxic Metabolic Encephalopathy
4. Toxic Metabolic Encephalopathy has been ruled out
5. Other (Please provide supporting information)

“Tell me you work for HCA, without telling me you work for HCA….”

 

[Janders]

-Partial seizure.
-Near syncope presenting with recrudescent stroke sz for a dozen possible reasons
-De novo aphasic TIA
-Saw ghosts; sudden karmic realization and enlightenment.
-is there an icd-10 code for brain fart?

 

[thegenius]

I would not let you take care of my family.

Then you can leave the ER and go to another one down the road. NEXT!

 

[Arcan57]

Thinking partial seizure given hx of recurrent head trauma recently.

 

[WilcoWorld]

To me he looks nauseated, as if he's about to faint. Seems most like a near syncopal event - I think @Janders idea of recrudescence is an interesting extra possibility on top of just temporary global hypoperfusion. He also looks a bit unsteady, again, like someone about to faint.

The absence of any lip smacking/eye movements, plus his age, seem to make absence seizure much less likely, but I acknowledge it can't be ruled out.

 

[han14tra]

It looked like near syncope to me. He said he was lightheaded. Look closely and see that he was pale and diaphoretic. Poor perfusion to the brain lead to that IMO. Once he took a break and sat down, he was better.

 

[emergentmd]

You guys r overthinking this.

1. CT, pan labs, ekg, cxr
2. Call hospitlaist
3. Move on. Majority of the time the neurologist won’t have an answer anyhow.

 

[Siggy]

Slightly off topic...

...but my favorite antiquated medical term will always be "subacute befuddlement." Definitely better than the new hotness... delirium.

 

[Zebra Hunter]

Looks like a pretty clear cut near syncopal episode. He appears quite unsteady on his feet. Although this discussion of people saying he was aphasic from a TIA or having a seizure just brings me back to how annoying these patient and mostly patient family interactions can be when they describe clear cut syncope prodrome, lack of focal neuro deficits, and near immediate return to mental baseline and you explain this to them, and you get the “I’m a nurse/doctor, I know what I saw, this was a” insert stroke/seizure/TIA. I’ve found that even many of my EM colleagues have a hard time differentiating syncope from seizure when it is happening right in front of them.

 

[MechEDoc]

It just has so few characteristics of a TIA. TIAs don’t make you freeze like that. He didn’t move a muscle for 20ish seconds. What part of the brain do you make transiently ischemic to produce that? The basiliar artery?

Expressive aphasia + OMG why can't I talk = staring like an idiot.

 

[AlmostAnMD]

Looks like a pretty clear cut near syncopal episode. He appears quite unsteady on his feet. Although this discussion of people saying he was aphasic from a TIA or having a seizure just brings me back to how annoying these patient and mostly patient family interactions can be when they describe clear cut syncope prodrome, lack of focal neuro deficits, and near immediate return to mental baseline and you explain this to them, and you get the “I’m a nurse/doctor, I know what I saw, this was a” insert stroke/seizure/TIA. I’ve found that even many of my EM colleagues have a hard time differentiating syncope from seizure when it is happening right in front of them.

1000% agree

who knows why, probably mix of hydration/old/standing, but his brain briefly didn't get enough oxygen to process anything and is just fortunate he didn't fully syncopize

 

[ProReduction]

It just has so few characteristics of a TIA. TIAs don’t make you freeze like that. He didn’t move a muscle for 20ish seconds. What part of the brain do you make transiently ischemic to produce that? The basiliar artery?

After doing > 10,000 acute stroke alert consults I can say you are 100% correct in that it was not a TIA, but 100% of EMTs in the U.S. would triage it as a "TIA" and 100% of receiving EDs would call it as a "TIA". This is why nobody has a local in-person Neurologist anymore.

I did watch the video. It was not consistent with TIA. It was most consistent with a complex partial seizure ("focal impaired awareness seizure") although pre-syncope is absolutely a possibility as well. It has been reported he is anticoagulated and has had multiple prior falls with mild TBI. I would not be shocked if he has a history of SDH (highly epileptogenic).

The fact that your average ED MD has to field 20 of these a day with all family members claiming "Pop had a stroke!" is why you all should uniformly make 7 figures IMO.

 

[dchristismi]

Now remember that I practice in the south (or south of the Deep South, if you prefer)...and I dare say he caught the vapors.
How's THAT for an antiquated medical term?

My vote is for near-syncope.
Edited to add: Also, if he had a h/o SDH, wouldn't it be more likely he would NOT be anticoagulated? Gravity is a bitch.

 

[Postictal Raiden]

After doing > 10,000 acute stroke alert consults I can say you are 100% correct in that it was not a TIA, but 100% of EMTs in the U.S. would triage it as a "TIA" and 100% of receiving EDs would call it as a "TIA". This is why nobody has a local in-person Neurologist anymore.

I did watch the video. It was not consistent with TIA. It was most consistent with a complex partial seizure ("focal impaired awareness seizure") although pre-syncope is absolutely a possibility as well. It has been reported he is anticoagulated and has had multiple prior falls with mild TBI. I would not be shocked if he has a history of SDH (highly epileptogenic).

The fact that your average ED MD has to field 20 of these a day with all family members claiming "Pop had a stroke!" is why you all should uniformly make 7 figures IMO.

Focal seizure with impaired awareness originated from the mesial temporal lobes. They are typically associated with automatism.
If his seizure is secondary to old SDH, it would be coming from the adjacent compressed cortex (frontal or parietal). He would exhibit motor symptoms.

This is a presyncopal event that almost every elderly has experienced once or twice in their life.

No need to pull the lever on a million dollar neurological work up (MRI, angio, echo, eeg) and end up being meh “let’s put him on DAPT for 21 days” or “put him on Keppra 500mg bid”

 

[Birdstrike]

You guys see that video of him? He was talking and just froze.

It's obvious what happened. The incident occurred on 7/27. He clearly flashed back to the Watkins Glen Soundcheck Jam from 7/27/73 and was overcome with beauty. Can't blame him, tbt

 

[ProReduction]

Focal seizure with impaired awareness originated from the mesial temporal lobes. They are typically associated with automatism.
If his seizure is secondary to old SDH, it would be coming from the adjacent compressed cortex (frontal or parietal). He would exhibit motor symptoms.

This is a presyncopal event that almost every elderly has experienced once or twice in their life.

No need to pull the lever on a million dollar neurological work up (MRI, angio, echo, eeg) and end up being meh “let’s put him on DAPT for 21 days” or “put him on Keppra 500mg bid”

Yes, SDH can affect the temporal lobe for sure and you do not need to have significant mass effect to have seizure from SDH. I am not saying he certainly has a SDH affecting the temporal lobe, just saying that I would not be surprised if he did. I've seen dozens of patients with no symptoms from SDH other than seizure and with no motor deficits at all. He could have a new GBM or many other causes of seizures originating in the temporal lobe. Also, automatisms are very frequently absent in complex partial seizures. If you require them for a dx of complex partial seizures then you are missing tons of seizures.

I also agree that this could have been presyncope. I already said that. Without a time machine and full ECoG coverage, we will never know. The one certainty was that it was not a TIA so lets stop the stroke code madness and protect our EM brothers/sisters from the medmal liability monster. 50% of Neurologists would have gladly called this a "TIA" and sent the guy home on DAPT.